Provider Demographics
NPI:1336603901
Name:WONG, KRAMER SATORU (RPH)
Entity Type:Individual
Prefix:
First Name:KRAMER
Middle Name:SATORU
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 N POINT WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1066
Mailing Address - Country:US
Mailing Address - Phone:916-622-8988
Mailing Address - Fax:
Practice Address - Street 1:1710 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-1804
Practice Address - Country:US
Practice Address - Phone:209-838-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist